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Integrated Use of Late Gadolinium Enhancement and Left Ventricular Global Longitudinal Strain in Hypertrophic

Soongu Kwak1, Jihoon Kim2, Min-Ha Jeong1

  • 1Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Division of Cardiology, Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea.

JACC. Asia
|September 30, 2025
PubMed

Insights

Integrating late gadolinium enhancement (LGE) and left ventricular global longitudinal strain (LV-GLS) improves risk stratification in hypertrophic cardiomyopathy (HCM). Patients with high LGE and low LV-GLS face the highest cardiovascular event risk.

Area of Science:

  • Cardiology
  • Cardiovascular Imaging
  • Biomarker Research

Background:

  • Hypertrophic cardiomyopathy (HCM) involves complex left ventricular remodeling.
  • Late gadolinium enhancement (LGE) and left ventricular global longitudinal strain (LV-GLS) are key markers of this remodeling.

Purpose of the Study:

  • To assess the combined prognostic value of LGE and LV-GLS for risk stratification in HCM patients.
  • To determine if integrating these markers enhances prediction of cardiovascular events.

Main Methods:

  • Retrospective analysis of 652 HCM patients undergoing cardiac magnetic resonance (CMR) between 2008-2020.
  • Measurement of LGE percentage and LV-GLS (absolute value).
  • Primary outcome: composite cardiovascular events (CV death, sudden cardiac death, heart failure hospitalization).

Main Results:

  • Higher LGE% and lower LV-GLS were independently associated with increased CV events.
  • Patients with high LGE% (>4.2%) and low LV-GLS (<14.3%) exhibited the highest CV event incidence (aHR: 2.88).
  • Mediation analysis revealed LGE% indirectly impacts CV events via LV-GLS, with highest sudden cardiac death risk in this subgroup.

Conclusions:

  • LGE and LV-GLS offer complementary prognostic insights in HCM.
  • Combining LGE and LV-GLS significantly improves risk stratification.
  • Patients with elevated LGE and reduced LV-GLS require intensified monitoring and management.
Abstract

Keywords:
cardiomyopathyglobal longitudinal strainhypertrophicmagnetic resonance imaging

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